266e - Epidemiology of Cardiovascular Disease Flashcards
Summarize the global epidemiology of cardiovascular diseases.
“Cardiovascular disease (CVD) is now the most common cause of death worldwide. Before 1900, infectious diseases and malnutrition were the most common causes, and CVD was the responsible for less than 10% of all deaths. In 2010, CVD accounted for approximately 16 million deaths worldwide (30%), including nearly 40% of deaths in high.income countries and about 28% in low- and middle-income countries.”
What are the five stages of the epidemiologic transition?
Pestilence and famine, receding pandemics, degenerative and man-made diseases, delayed degenerative diseases, and epidemic of inactivity and obesity.
Characterize the age of pestilence and famine.
“The age of pestilence and famine is marked by malnutrion, infectious diseases, and high infant and child mortality that are offset by high fertility. Tuberculosis, dystentery, cholera, and influenza are often fatal, resulting in a mean life expectancy of about 30 years. CVD, which accounts for less than 10% of deaths, takes the form of rheymatic heart disease and cadiomyopathies due to infection and malnutrition. Approximately 10% of the world’s population remains in the age of pestilence and famine.”
Characterize the receding pandemic age.
“Per capita income and life expectancy increase during the age of receding pandemics as the emergence of public health systems, cleaner water supplies, and improved nutrition combine to drive down deaths from infectious disease and malnutrition. Infant and childhood mortality also decline, but deaths due to CVD increase to between 10 and 35% of all deaths. Rheumatic valvular disease, hypertension, coronary heart disease, and stroke are the predominant forms of CVD. Almost 40% of the world’s population is currently in this stage.”
Characterize the age of degenerative and man-made diseases.
“The age of degenerative and man-made diseases is distinguished by mortality from noncommunicable diseases - primarily CVD - surpassing mortality from malnutrition and infectious diseases. Caloric intake, particularly from animal fat, increases. CHD and stroke are prevalent, and between 35 and 65% of all deaths can be traced to CVD. Typically, the rate of CHD deaths exceeds that of stroke by a ratio of 2:1 to 3:1. During this period, average life expectancy surpasses the age of 50. Roughly 35% of the world’s population falls into this category.”
Characterize the age of delayed degenerative diseases.
“In the age of delayed denenerative diseases, CVD and cancer remain the major causes of morbidity and mortality, with CVD accounting for 40% of all deaths. However, age-adjusted CVD mortality declines, aided by preventive strategies (for example, smoking cessation programs and effective blood pressure control), acute hospital management, and technologic advances, such as the availability of bypass surgery. CHD, stroke, and congestive heart faiulure are the primary forms of CVD. About 15% of the world’s population is now in the age of delayed degenerative diseases or is exiting this age and moving into the fifth stage of the epidemiologic transition.”
Summarize the percentage of the world in the different era ages and the rate of cardiovascular deaths in those countries.
- Pestilence and famine: 10% world, less than 10% CVD deaths;
- Receding pandemics: 40% world, 10-35% CVD deaths;
- Degenerative and man-made: 35% world, 35-65% CVD deaths;
- Delayed degenerative: 15% world, 40% CVD deaths.
Name the etiology of cardiovascular diseases in the countries in different era ages.
- Pestilence and famine: rheumatic valvular disease;
- Receding pandemics: rheumatic valvular disease, hypertension, coronary heart disease, and stroke;
- Degenerative and man-made: coronary heart disease and stroke;
- Delayed degenerative: coronary heart disease, stroke, and congestive herat failure.
High-income countries experienced declines in CVD death rates by as much as 50-60% over the last 60 years, whereas CVD death rates increased by 15% over the past 20 years in the low- and middle-income range.
True or False?
True.
Summarize the historic evolution of eras age in the United States related to CVD.
” The age of pestilence and famine occured before 1900, with a largely agrarian economy and population. Infectious diseases accounted for more deaths than any other cause. By the 1930s, the coutnry proceeded through the age of receding pandemics (…) Lifestyle changes due to rapid urganization resulted in a simultaneous increase in CVD mortality rates, reaching approximately 390 per 100 000.. Between 1930 and 1965, the country entered the age of degenerative and man-made diseases. Infectious disease mortality rates fell to fewer than 50 per 100 000 per year (…) The age of delayed degenerative diseases took place between 1965 and 2000.”
Specify the decline CVD death rate in the United states through 1970s to 2000s.
“Currently, the United States is entering what appears to be a fifth fase. The decline in the age-adjusted CVD death rate of 3% per year through 1970s and 1980s has tapared off in the 1990s to 2%. However, CVD death rates have declined by 3-5% per yer during the first decade of the new millennium.”
What are the rates of CVD to stroke rates in high-income countries?
5 to 1
Compare the mortality rates in northern versus central and southern Europe.
“… southern and central European countries experienced a more gradual rise and fall in rates. More specifically, central European countries declined at slower rates compared to their northern counterparts. Countries such as Portugal, Spain and Japan never reached the high mortality rates that the United States and other countries did, with CHD mortality rates at 200 per 100 000, or less. Europe also exhibit a clear north/south gradient in absolute rates of CVD, with rates highest in northern countries and lowest in Mediterranean countries.”
Japan is unique most likely due to the unique dietary patterns of its population. Stroke rates increasd dramatically but CHD rates did not rise as sharply in Japan.
True or False?
True.
CVD is a major cause of death in China, but like Japan, stroke causes more deaths than CHD in a ratio of about three to one.
True or False?
True.
